Neal Jain, MD: Addressing Inflammatory Disease Overlap with Biologics


The introduction of biologics such as dupilumab have opened avenues of care for patients with overlapping disease.

Monoclonal antibody biologics, designed to target the critical pathways linked to inflammation, have changed the scope of care across numerous indications. But patient-tailored treatment personalization still eludes clinicians.

In an interview with MD Magazine® at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, Neal Jain, MD, director of the Arizona Allergy and Immunology Research Center, explained how clinical trials have focused on biologics’ success in allergic/immunologic indications—but none have compared biologics in particular patient groups.

The next step for improving the state of biologic therapy lies in weighing them across different patient populations.

MD Mag: What’s the most pressing issue to address with the advancement of biologics in allergy/immunology?

Jain: Depending upon the disease state, there are therapies that have overlapping activity from a biologic standpoint, but they're not entirely overlapping. They're certainly individualized and specific to specific pathways, like inflammatory pathways. And so, how do we pick which one? And in what disease state are we going to pick which one right? I mean, I think this is further along with regards to asthma and severe asthma, and that having been said, we still are having these really significant debates about, ‘Is this the same patient population, or are we looking at different patients?’ And, ‘How do we choose 1 biologic intended for severe asthma over another?’

There haven't been head-to-head studies, and it's unlikely that we'll have that kind of data—at least in a palpable or meaningful way for some time. So then, the question is how can we dissect this data that we have available to understand which therapy is going to be best for which individual?

I think that is there is some information that is available. I think that maybe we haven't looked at things in a way that has been looked at in the past, and hopefully we'll start to see some of that. And I think adding to that, what we're seeing with regards to genomics and biomarkers and those kinds of things, it's really getting to be interesting. There's some posters, abstracts that are being presented that'll help to clarify what I believe is that these are—at least when you look at severe asthma population—a highly overlapping group of individuals. And I think that when you look at studies have been done, they're not really all that significantly different.

And there are some finer points that we're starting to see with regards to the different biologics that might help us identify which patient might benefit from 1 versus another. I think a lot of it comes down to comorbid diseases. So, you know—we see these patients with severe asthma that also have chronic rhinosinusitis, nasal polyps, atopic dermatitis, or food allergies. and that I think will help us to say, ‘OK, we may be wanting to think about this biologic versus that biologic, because of the activity, and how the different biologics affect the different pathways,’ and being able to dovetail the mechanism of action to work for both different disease states.

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